Enhancing first-line treatment for Colorectal Cancer with Genomic Profiling and Predictive Diagnostics

Authors Dr. Kimberly Blackwell, Tempus Chief Medical Officer

The American Cancer Society estimates there will be 106,180 new cases of colon cancer and 44,850 new cases of rectal cancer diagnosed in the United States this year, making colorectal cancer the third most common cancer diagnosed among both men and women. Thanks to early detection and prevention efforts, including the U.S. Preventive Services Task Force’s recommendation that adults between 45 and 75 be screened regularly for colorectal cancer, the overall rate of colorectal cancer has decreased since the mid-1980s. But a 2018 study published in the Journal of the National Cancer Institute revealed a troubling trend in the incidence of CRC among young adults: those born in 1990 face double the risk of developing colon cancer and quadruple the risk of developing rectal cancer than those born in 1950. 

At last year’s American Society of Clinical Oncology (ASCO) Annual Meeting, our team presented research on the impact of first-line genomic profiling in detection of actionable alterations in metastatic colorectal cancer, along with the associated diagnostic testing costs in a modeled US health plan setting of 5 million lives. We found that replacing 20% of standard of care testing with Tempus xT, our tumor/normal NGS assay covering 648 genes, was associated with a small incremental testing cost, but led to identification of actionable alterations in a meaningful number of patients. For every 8 first-line patients with metastatic colorectal cancer tested with Tempus xT, rather than typical molecular testing, 1 additional patient was expected to have currently actionable alterations. 

We are also leveraging our molecular and clinical database to develop predictive algorithm laboratory-developed tests that inform the treatment of patients with cancer. Last year, we launched our DPYD algorithm which assesses relevant mutations in the DPYD (dihydropyrimidine dehydrogenase) gene. DPYD is a known biomarker for adverse events associated with 5-FU/Capecitabine chemotherapy, which is used to treat colorectal cancer. The Tempus DPYD test provides clinicians with insight into which patients might benefit from closer monitoring or dose reduction and its value was underscored in a recent study published in The Oncologist Journal. A meta-analysis of 25 separate studies involving 13,929 patients revealed that those with certain pathogenic variants of the DPYD gene who received standard-dose fluoropyrimidine chemotherapy were more than 25 times the risk for treatment-related death than those without the variant. Tempus’ DPYD algorithm tests for all four of the pathogenic variants reviewed in the meta-analysis while many other tests on the market do not. 

As Colorectal Cancer Awareness Month comes to an end, we look forward to adding to our growing collection of tests as we work to empower clinicians to deliver personalized treatment for individual patients throughout their cancer journey.